Medicare solutions for individuals and groups

Overview

Fallon Medicare Plus Premier HMO is our Medicare Advantage Plan for retirees that offers comprehensive coverage and more benefits than members would get with Original Medicare alone.

We offer two providers networks with our Medicare Advantage HMO plans: 
Fallon Medicare Plus Central Premier and Fallon Medicare Plus Premier.

Fallon Medicare Plus Central Premier is available only to residents of Worcester County. Members receive care and services from a tailored selection of providers based in the central part of the state.

Fallon Medicare Plus Premier is available to all eligible plan members. This network includes all of our contracted providers throughout the state—from Boston to the Berkshires.

Both plans include rich benefits like:

• Benefit Bank—a card that can be used to pay for dental care, fitness memberships, eyewear and/or hearing aids.
• Free on-demand workouts, livestream fitness classes and gym membership through SilverSneakers® (in addition to the Benefit Bank)
• Free 13-consecutive week WW (formerly Weight Watchers®) membership
• Prescription drug coverage with no coverage gap
• Hearing aid benefit (in addition to the Benefit Bank)
• Preventive and comprehensive dental care (in addition to the Benefit Bank)
• $150 toward eyewear, every year (in addition to the Benefit Bank)

Eligibility

To be eligible for Fallon Medicare Plus Premier HMO, members must:

• Be eligible for a Medicare group plan through an employer or a union health and wellness organization
• Be enrolled in Medicare Part A and Part B
• Continue to pay their Medicare Part B premium or have it paid for by another source
• Reside within the approved service area.

Service area

To be eligible for Fallon Medicare Plus Central Premier, retirees must be a resident of Worcester County.

To be eligible for Fallon Medicare Plus Premier, retirees must live in one of the following Massachusetts counties: Barnstable, Berkshire, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk or Worcester. Or, they may reside in specific cities or towns that border Massachusetts, as seen in the map below.

See a larger version of this map

Plan documents

• Fallon Medicare Plus Central Premier Evidence of Coverage
  
• Fallon Medicare Plus Premier Evidence of Coverage
• Schedule of Benefits - RWV0
• Schedule of Benefits - RWW0
• Schedule of Benefits - RPW0
• Schedule of Benefits - RWF0
• Fallon Medicare Plus Central Premier Provider Directory
• Fallon Medicare Plus Premier Provider Directory
• Pharmacy directory
• Formulary

Online tools

• Find a doctor
• Find a pharmacy
• Online formulary

Overview

Fallon Medicare Plus Freedom is our coast-to-coast health care coverage solution for Medicare-eligible retirees, whether they live in Wellfleet or West Palm Beach.

With Fallon Medicare Plus Freedom, members get more benefits than they would with Original Medicare alone. And, with no provider network, plan members have the freedom to see any provider who accepts Medicare and is most convenient for them.

Fallon Medicare Plus Freedom acts as a secondary payer for Medicare-approved services, and covers costs not paid by Medicare for services such as:

• Doctor office visits
• Tests and screenings, including X-rays and labs
• Hospital admissions
• Durable medical equipment, including wheelchairs and oxygen
• Emergency care inside and outside the U.S.

Fallon Medicare Plus Freedom plan options include those with and without prescription drug coverage.

Fallon Medicare Plus Freedom also includes the It Fits! benefit—a $200 annual fitness reimbursement that members can use for anything from gym memberships at the gym of their choice to yoga classes, ski lift tickets, livestream fitness services and Peleton subscriptions.

Eligibility

To be eligible for Fallon Medicare Plus Freedom, members must:

• Be eligible for a Medicare group plan through an employer or a union health and wellness organization
• Be enrolled in Medicare Part A and Part B
• Continue to pay their Medicare Part B premium or have it paid for by another source.

Service area

Fallon Medicare Plus Freedom is available to retirees who live in the United States.

Plan documents

• Evidence of Coverage
• Schedule of Benefits - plan code RCL0
• Schedule of Benefits - Town of Palmer
• Schedule of Benefits - plan code RCH0
• Schedule of Benefits - plan code RCND
• It Fits form
• Proof of Coverage - information for your providers